Open AccessEngaging people who inject drugs and their peers in HIV testing and harm reduction in Ukraine: do they make a difference?
Author(s) -
Nataliia Kravchenko,
Olga Denisiuk,
Julia Kuznetsova,
Joshua Chadwick Jayaraj,
Rony Zachariah,
Pavlo Smyrnov
Publication year - 2019
Publication title -
journal of infection in developing countries
Language(s) - English
Resource type - Journals
eISSN - 2036-6590
pISSN - 1972-2680
DOI - 10.3855/jidc.11293
Subject(s) - harm reduction , medicine , human immunodeficiency virus (hiv) , harm , psychological intervention , family medicine , psychiatry , psychology , social psychology
People Who Inject Drugs (PWID) should be offered HIV-testing and harm reduction services. We assessed the effectiveness of including PWID and their peers in HIV-testing by comparing for a period before (2013-2014) and after their introduction (2015-2017), the a) numbers HIV tested b) number enrolled in harm reduction and c) frequency of HIV-testing.
Methodology: An analysis of programme data involved PWID aged ≥ 14 years (1st January 2013-31st December 2017) in Ukraine. Between 2013-2014, HIV-testing (VCT) was done by trained health workers. From 2015, this was Directly Assisted HIV Self-testing (DAST) done by social workers and peers. Optimized HIV case finding (OCF) was introduced (in 2016) as an overlapping strategy with DAST.
Results: A total of 844,837 HIV tests were done with 23,427 (2.8%) HIV-positive results. With VCT, there were 164,417 HIV tests compared to 639,685 after engagement of PWID and their peers (>3-fold increase). The highest HIV positive yield (20%) was when OCF was included. With increasing HIV-testing caseload, a progressive decrease in enrollment in harm reduction was seen (85% in 2014 to 47% in 2017, X2 for trend P < 0.001). OCF resulted in enrollment into harm reduction of 2722 HIV-positives, which was 35% higher than through DAST alone (7,5%). HIV re-testing almost doubled with DAST.
Conclusion: Active engagement of PWID and their peers in HIV-testing increased uptake of HIV-testing. Including OCF has a synergistic effect in HIV-positive yield. Strategies are urgently needed to ensure that individuals who are HIV tested are enrolled in harm reduction.